Unit13 child and adolescent psychiatryonline
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Transcript of Unit13 child and adolescent psychiatryonline
Child and Adolescent Psychiatry
Standard Autistic Disorder
DSMIV-TR (A, B, or C)
A. Six or more items from 1,2, or 3.
1. Qualitative impairment in social interaction
Multiple non-verbal behaviors and gestures
Failure to develop peer relationships
Lack of sharing social enjoyment
Lack of social reciprocity
2. Qualitative impairment in communication
Delay in spoken language
Marked impairment in sustaining conversations
Repetitive use of language or idiosyncratic language
Lack of make believe play
3. Stereotyped behavior
Abnormal preoccupation with a pattern of interest
Inflexible routines or rituals
Repetitive motor mannerisms
Persistent pre-occupation with parts of objects
B. Delays in at least one of the following
Social interaction
Social communication
Symbolic or imaginative play
C. Not accounted for by Rett’s or another disintegrative disorder
Asperger’ Syndrome
Usually first observed after age 2
Oddity of social interaction
No language impairment
Mild mental retardation to normal IQ
Seizure disorder common
Social interactions can be mastered
Rett’s Disorder
Observed only in females
Cause unknown
Normal prenatal and peri-natal development
Loss of previously acquired hand skills, social engagement, gait and language between 5 and 30 months
Onset before age 4
Severe mental retardation
Seizure disorder
Poor prognosis
Childhood Disintegrative Disorder
More common in males
Normal development for 2 years
Loss of previously acquired language, social, bowel and bladder, play and motor skills before age 10
Outcome very poor
Differential diagnosis
Schizophrenia with childhood onset
Mental retardation with behavioral symptoms
Mixed receptive-expressive language
Acquired aphasia
Schizophrenia with Childhood Onset
Pre-pubertal onset extremely rare
Neuro-developmental abnormalities
No onset before the age of 5
Normal intelligence
Command hallucinations
Bizarre delusions
Loose associations
Thought blocking
Mental Retardation with Behavioral Symptoms
Chromosomal problems
Metabolic disorders
Over 1000 genetic or metabolic causes
Mixed Receptive-expressive Language
Impaired skills in language comprehension and understanding
May also have auditory impairment; i.e. sound discrimination, memory of sound sequences
Difficulty processing visual symbols
Developmental lags
Long term social problems
Mixed Receptive-expressive Language
Selective deficit in language skills
Poor ability to express self
Immature articulation
Acquired Aphasia
Difficulty remembering words
Secondary to brain trauma, tumors, or seizure disorder
Preceded by normal language development
May start to talk again
Prognosis unsure
Attention Deficit Hyperactivity Disorder
Inattention
Hyperactivity
Impulsivity
Low tolerance for frustration
Temper outbursts
Oppositional Defiant Disorder
Evident before age 8
Stubborn
Argumentative
Limit testers
Refusal to accept blame
Deviant behavior with authority figures
No serious violations of rights of others
Symptoms most evident at home
Severe power struggles
Conduct Disorder
Evident by age 10
Behavior outside of societal norms
Aggression towards people and animals
Destruction of property
Deceitfulness and/or theft
Serious violations of rules
Violation of rights of others
More common in males
Conduct Disorder cont’d
Poor peer relationships
Lack of feelings of guilt or remorse
Low self-esteem
School discipline problems
Boys: Fighting, stealing, vandalizing
Girls: Truancy, substance abuse, run aways, prostitution
Tourette’s Disorder
Genetic transmission
70% of female offspring inheriting the gene develop the illness
99% of males inheriting the gene develop the illness
Permanent progressive illness
Possible periods of remission
Tourette’s Disorder, cont’d
Onset age 2-10
Motor tics Eye blinking
Tongue protrusion
Touching
Squatting
Skipping
Verbal tics Barking
Grunts
Clicks
Yelps
Tourette’s Disorder, cont’d
Obsessions and compulsions
Hyperactivity
Distractibility
Impulsivity
Low self-esteem
Adjustment Disorder
Emotional response to an identifiable stressor
Inception within 3 months of stressor
Decreased school performance
Temporary changes in social relationships
Ceases after 6 months
Subtypes Anxiety
Mixed anxiety and depression
Conduct disturbance
Mixed conduct and emotion disturbance
Childhood Eating Disorders
Pica
Rumination Disorder
Feeding and Eating Disorder
Pica
Persistence in eating non-nutritive substances
Paint –plaster-dirt- animal feces
No aversion to eating food
Frequently associated with mental retardation
Rumination Disorder
Repeated regurgitation and re-chewing food
Lack of nausea, retching, or GI problems
May occur with developmental delays
Feeding and Eating Disorder
Infant or child does not eat adequate amounts of food
No medical disorder or mental retardation
Food is available
Failure to gain weight
Experiences developmental delays